Dr. Brett Graham enjoys a good “diagnostic puzzle,” which is what in part has attracted him to pursue a post-residency specialty in neuro-immunology. He has been surprised by how much he enjoys walking with his patients, even during difficult moments. Juggling family life (Brett and his wife just welcomed their third child) with his residency work schedule means that Brett spends most of his free time playing around the house with his kids.
What is your background and how did your path lead to Vanderbilt?
I’m originally from just outside of Orlando, and I grew up with three younger brothers. I attended undergrad at Brigham Young University. Around that time, I took two years off to serve as a missionary for my church in Mexico. After I finished my degree, I went to Cleveland Clinic for medical school. From there, I landed here at Vanderbilt.
I met my wife during undergrad, but she is originally from Mexico City. Our two boys, who are now ages 4 and 2, were born while we were in Cleveland for medical school. Just this past November we welcomed a little girl. Nashville is great so far! It’s a good place to be with little kids and there’s lots of opportunities for outdoor activities. I have also really enjoyed working with my colleagues. Everyone here has been super supportive and easy to work with.
What have been some of the greatest challenges of residency so far?
I would have to say intern year in general. The schedule is intense, which means I had to be away from home a lot. Another big challenge early on was feeling a lack of initial competency. I very vividly remember my second month as an intern in the medical ICU and feeling as if I had no idea what I was doing and being responsible for these very complicated patients. Fortunately that has improved over time!
Have you experienced any unexpected rewards or highlights during residency?
I feel like there have been a lot of situations, more than I estimated, in which I find myself having deep, end-of-life discussions with patients. We walk alongside patients and their families as they face the end of their life, severe disability, or otherwise challenging future. While it can weigh on me a bit if I have several of these conversations back-to-back, I have enjoyed being part of that aspect of patient care. It’s a somewhat “sacred” time. One often goes into medicine thinking you’re going to be a hero, but you don’t realize that a big part of inpatient medicine deals with these more difficult topics. But I’ve realized this can be rewarding as well.
What are your specialization interests? What are your current plans post-residency?
I’m currently applying for fellowships in neuro-immunology. I plan on treating patients with MS and other autoimmune diseases. I also have a side interest in infectious disease of the nervous system, so I may combine a little of that into my fellowship as well. Neuro-immunology fellowships vary a lot by institution, so I can kind of make it my own.
What is attractive to you about neuro-immunology?
I like to be the detective—I love a good puzzle and diagnostic challenge. Those disorders [often seen in neuro-immunology] often mimic other things and are difficult to figure out. It’s also a specialty more based in the patho-physiology of the disease instead of a specific manifestation or anatomic localization like other specialties are. It’s also a specialty where you have close longitudinal care with patients, so you end up delving into other areas of their life and how the disease impacts those as well.
What has been the most valuable lesson you have learned from residency so far?
For me and my personality, it’s been learning how to triage–both in the medical sense and the “work-life balance” sense of the word. Since I’m not naturally good at it, I’ve had to learn and struggle with it. I’m someone who wants to do everything for everyone. When you’re put in a position when you have to triage, it serves as a valuable lesson.
How do you like to spend your free time? What are your other interests and hobbies?
I spend most of my time playing with my kids and helping out around the house. When I first get home from work, the first thing the boys usually want to do is rough-house. Other than that, we like to go for a ride on their trikes, throw balls, read books, or play simple games.
When I get the chance I like going to the gym, weightlifting, and mountain biking. Also if we have time, my wife and I enjoy traveling–we used to do more of it!
What are the challenges of juggling residency with having a family?
It’s really tough but I wouldn’t have it any other way. Fortunately I’ve had a lot of support from my wife. She really loves being a mom and does a really good job of it. I owe the ability to juggle both of these parts of my life mostly to her.
What would your career be if not neurology?
Realistically, I would probably be a researcher in another biomedical field. That said, I used to be much more into digital photography and video, and I would make videos of cool places we went. So a dream job would be to be a “Instagrammer/travel photographer” where I could just travel to cool places and take pictures.
